An interview with Prof. Dr. Mehmet Zihni Sungur, founder and president of the Association for Cognitive Behavioral Therapies in T\u00fcrkiye and former president of the European Association for Cognitive and Behavioral Therapies, covering topics such as football, medicine, Turkey, Europe, associations, education, obsessive-compulsive disorder, and depression. Transcribed from a live recording\u2026<\/p>\n
Interview: Ozanay Alpkan<\/p>\n
OA: As always, we can start with your 'career path'... How did you define your area of expertise? How did it progress?
\nMZS: When you say my career path, are you asking about my education or my job? I'm not sure. My secondary education was at Tarsus American High School. It started in college. After graduating from there, my most important goal was to continue in a sport I enjoyed in my youth and wanted to pursue professionally \u2013 to become a football player. But when my father said, "Either football or me," I gave up football and found myself in medical school. After finding myself in medical school, very early in my studies, in my second year, I thought, "Where can my profession and my worldview be reconciled?" My profession was medicine, and my worldview was to travel the world and get to know life more closely through interpersonal communication. I turned to Psychiatry, a field where I thought the two were compatible and where I could be more social. My decision to pursue Psychiatry was greatly influenced by my esteemed professor, Dr. Do\u011fan Kara, from Hacettepe Medical Faculty, who has since passed away. After entering psychiatry, I realized that after all those years of medical training (six years of scientifically based medical education), I didn't want to practice my profession by doing whatever I wanted, or within a psychotherapy approach that wasn't yet supported by sufficient scientific data. This was because the dominant psychotherapy approaches during my residency were Analytic and Psychodynamic. These approaches lacked sufficient scientific data; they were largely based on hypothetical models.<\/p>\n
\u201c"The model presented in those years was a model presented far too early."\u201d
\nFollowing this, I began to think, "Is there a more scientific and grounded approach to psychotherapy, and where can I find it?" During my years as an assistant, I primarily tried to research how psychiatric or mental health services were delivered to the public. At that time, there were large mental hospital models. I set out to examine the differences between these 'large mental hospital' models and the models called 'Community Psychiatry'. This happened in Nottingham, England, through a Council of Europe scholarship. When I returned to T\u00fcrkiye, I presented these models comparatively to the Ministry of Health at the time. In the mid-1980s, I tried to bring to the forefront a more advanced version of the model that is only now beginning to be offered in T\u00fcrkiye through community mental health centers. This model was about treating individuals with 'mental health problems' directly within the community, without confining them to what are known today as mental hospitals. But I suspect that this model, presented in those years, was presented too early. The current approach has only recently begun to do this. However, we presented it back then. Perhaps this attempt to hastily force a baby who is not yet ready to walk to walk was not sufficiently understood or listened to\u2014or taken seriously enough.<\/p>\n
So, in my second year, I went to London with a British Council scholarship to focus on a more grounded and newly popular type of psychotherapy called 'Behavioral Therapies'. 'Behavioral Therapies' was a scientifically based type of psychotherapy, derived from data obtained from both animal experiments and studies on volunteers. At that time, I underwent a two-year training period with Professor Isaac Marks, considered the father of these therapies. Working with him during this training period was both very enjoyable and very challenging because we never had time for tea or coffee during our assistantship. It was a high-paced work environment. He didn't often bring the English around because they had their 'tea-time', their need for tea. We didn't have that, couldn't have it. The discipline and intense pace \u2013 let's call it 'learned diligence' if you like \u2013 that came from working with him and Professor Crowe, who was working in the field of sexual therapies, which was just starting to become popular at that time, must have rubbed off on me a little too much, because for the last ten years, not a single Saturday or Sunday has been mine. Not next year either. Right now, I feel more strongly that there's a need to slow down a bit.<\/p>\n
\u201cThere are two things you cannot disprove: 1) things that are entirely true, 2) things that are so general that their truth or falsity cannot be demonstrated\u2026\u201d
\nI don't know how much we'll delve into the field of Behavioral Therapies, but it was clear that the dominant analytical or psychodynamic approaches of that period needed to be questioned, and that we needed more scientific information in interventions on individuals. Therapies were being applied, but to what extent were the theories underlying these applications scientific? As the hypotheses of psychoanalysis were tested, we gradually saw that the claims were too general, and even if not wrong, they weren't specific. In other words, you can't prove the falsity of two things: 1) things that are completely true, and 2) things that are so general that their truth or falsity cannot be demonstrated. And it became clear that the theories of analytical approaches were too general, meaning they possessed characteristics that could neither be proven right nor wrong. Furthermore, measurement, a requirement of scientific rigor, was impossible in analysis because concepts like the "unconscious" couldn't be measured. Also, while the treatment results from behavioral therapies were extremely promising, the results of psychoanalysis were only available through a few cases. Behavioral therapies achieved results within weeks, while the occasional positive results from psychoanalysis took years. As a result, 'Behavioral Therapies' gradually gained prestige, while the analytical approaches that were dominant at the time began to fade into the background.<\/p>\n
Behavioral therapies essentially mean 'a treatment approach that uses learning principles to create observable and measurable changes in human behavior.' In other words, we apply learning theories, and learning theories are entirely evidence-based approaches. These applications, built upon theoretical knowledge gained from studies with people and volunteers, have begun to be used to understand human behavior and change undesirable behaviors. The fact that behavioral changes are measurable and observable is useful in determining how effective the intervention is. The reason the approach is called behavioral therapy is because the behavior is observable and measurable, making it easy to determine whether the treatment is working or not. Emotions, however, are not easily measurable. Of course, this doesn't mean emotions are not valued. However, since behavioral changes bring about change, we call our approach behavioral therapy because it is measurable and observable. Over time, we have also learned that measuring and evaluating behaviors is very valuable, but there are also thoughts between events and emotions. The science that studies the processes between stimulus and response is called "Cognitive Science." Cognitive therapies help us understand why people react differently to the same events.<\/p>\n
It's not the 'events' that determine the emotion; it's 'the meaning you give to the events'.\u2018
\nWhat determines our emotional response at point C to an event we experienced at point A is not actually event A itself, but rather the interpretation of event A made at point B, which is invisible between A and C. Let's simply consider the event at point A as someone passing by without greeting you. Someone you know looks at you but doesn't greet you. At point C, various emotions may arise as a result. One of these could be 'anger'. When might it be anger? If at point B you thought, "Look at that guy, how arrogant. He didn't greet me." At point C, your emotion might be 'sadness'. When? At point C, if you thought, "He\/She realized I'm worthless and doesn't consider me worthy of a greeting," the feeling at point C might be 'guilt.' When? At point B, if you thought, "I must have done something to offend him\/her for him\/her not greeting me," the feeling at point C might be 'nothing.' When? If you thought, "It's God's greeting... What difference does it make whether he\/she greets me or not...", the feeling at point C might be 'a desire to go and help.' When? If you thought, "He\/She looked but didn't see me. Since he\/she didn't see me, he\/she must be distracted. Since he\/she is distracted, he\/she must have a problem.".<\/p>\n
Therefore, while Behavioral Therapies examine the relationships between 'stimulus' and 'response,' Cognitive Therapies examine the processes between 'stimulus' and 'response.' In other words, our thoughts, or in other words, the 'meaning we give to events,' determine our emotional responses to events. Cognitive Therapies are a treatment approach that works on these meaning-making processes. As you know, perhaps the most important characteristic of human life is how we 'make sense' of experiences. Because we learn when we make sense of things. How we make sense of things is entirely related to our past experiences. That is, our past experiences and our fundamental beliefs about ourselves and the outside world determine how we give meaning to events. Life is not equally generous to everyone. Our emotions determine our behaviors because how we feel determines how we will react. Let me put it more succinctly; \u2018Watch your thoughts; they become your feelings. Watch your feelings; they become your actions. Watch your actions; they become your habits. Watch your habits; they become your character. Watch your character; it becomes your destiny.\u2019 Looking at it this way, our lives can become what our 'thoughts' are.<\/p>\n
These two therapeutic approaches have combined to form what is now called 'Cognitive Behavioral Therapy'. Until 1995, I worked as a member of the British Association for Cognitive Behavioral Therapy because this organization did not exist in T\u00fcrkiye. In 1995, we established the Turkish Association for Cognitive Behavioral Therapy. I became the founding president of this association. We still have ongoing courses in Turkey and abroad. I hope that my valuable colleagues who have completed their training in this field will carry the torch of this association, which I have both founded and chaired, in the best possible way. I have done enough work in this field; I want to step back a little and dedicate time to my family.<\/p>\n
When we first founded the association, there wasn't much interest. There was also some scientific scrutiny and resistance. That's gone now, and these approaches are among the most popular therapies in the world. As you know, studies are more highly regarded in Europe. Thankfully, they elected me president of the European Association for Cognitive Behavioral Therapy in 1999, and I held that position until 2002. During this period, in 2001, we had the opportunity to hold the first European Congress on Cognitive Behavioral Therapy in T\u00fcrkiye. After that congress, we gradually started organizing national congresses. The international congress we held in 2011, in the words of Americans and participants from other European countries, became one of the 'unforgettables'. It was a congress attended by all the world-renowned people in this field \u2013 imagine, I've been in this field since 1987 \u2013 and because I had connections with all of them, both personally and scientifically, they came without even asking, "How much honorarium will you give us?" Now we've secured another European congress; If we stay on our feet, we'll do that in 2017 too.<\/p>\n
\u201c"Medicines are certainly valuable, but if there are approaches that are just as valuable as medicines, we should offer those options to people as well."\u201d
\nWe were discussing where Cognitive Therapies and Behavioral Therapies are used. They are used in almost all areas. If I were to say a few things about this approach; its most important feature is its effectiveness in what were once called 'resistant illnesses'. For example, diseases like Obsessive-Compulsive Disorder, which we commonly refer to as 'obsession'... In the past, these were even described as a kind of mental cancer. Today, thanks to these approaches, they can be treated to a large extent.<\/p>\n
One of the most important aspects of these treatments is that, in a group of very common illnesses like depression, they are at least as effective as medication in the initial stages of treatment, and twice as effective as medication in preventing relapses in the later stages. Research results show this. The rate of patients abandoning this treatment is lower than the rate of abandoning medication. The effectiveness of a treatment is not determined solely by the success rate at the end of treatment. Success is directly proportional to how many people are receptive to the treatment, how many people complete the treatment, and how many people maintain their recovery without relapse. Medications are certainly valuable, but if there are alternative approaches to medication, we should offer those options to those people as well.<\/p>\n
These treatments have been found to be quite effective in the field of anxiety disorders. When we say anxiety disorders, we are referring to phobias, obsessions, panic disorder, trauma-related problems, and 'anxiety disorder,' which is the most common illness today. In such cases, these therapeutic approaches have been found to be more successful than medication, both in the acute phase of the illness (i.e., at the beginning of treatment) and in the follow-up period (i.e., preventing relapses). The third area where this treatment is quite effective is eating disorders; that is, clinical conditions known today as Anorexia and Bulimia.<\/p>\n
Putting all that aside, the area I enjoy using the most is Couples Therapy and Sex Therapy. That is, addressing disruptions in relationships or sexual life between spouses. Even in schizophrenia, which was once considered "impossible to treat with therapy," significant strides have been made in therapy. According to British standards, if you haven't systematically administered at least 10 Cognitive Behavioral Therapy sessions to a chronically schizophrenic patient over six months, it can be perceived as "treatment not conducted under appropriate conditions." Of course, it's much more effective when used in conjunction with medication in schizophrenia treatment\u2026 It's effective even in cases where medication is most effective, such as delusions, hallucinations, and even bipolar disorder. Cognitive behavioral therapy also has a place in physical conditions like diabetes and pain, and even in internal diseases like irritable bowel syndrome. Our treatment is short, goal-oriented, and the goal is determined together with the patient. The goal might be to overcome a fear, get rid of obsessions, overcome obesity, or overcome panic attacks. The goal is to immerse the individual in the anxiety-provoking environment during distressing and anxiety-inducing situations, and to teach them how to cope with their anxieties. In other words, it aims to teach problem-solving techniques, to make sense of seemingly meaningless problems by establishing connections between current problems and past experiences, and to try to make the individual their own therapist.<\/p>\n
OA: You mentioned couples therapy. In your opinion, what is the most fundamental problem in relationships?
\nMZS: There's a situation that begins with love, where we idealize someone and see them the way we want to see them. I briefly define love as a 'vision impairment.' You see what you want to see. Marriage is the cure for this vision impairment because you see what is real, not what you want to see. The period of being in love is the time until you realize the difference between what you imagined and what is real.<\/p>\n
\u201cIn good marriages, people don\u2019t turn against each other because of problems; they face the problem together\u2026\u201d
\nIn marriages, the problem sometimes is that a relationship that began with love continues like that of two strangers. In other words, a 'communication' problem. The second most important issue is our 'problem-solving skills'. For example, when a problem arises, spouses often blame each other, saying, "It's your fault." However, in good marriages, people don't turn against each other because of the problem; they face the problem together. They become one team, and the problem becomes the opposing team. While many different problems are possible in marriage, the most important fundamental problem is communication, because no problem, regardless of its type, can be solved without good communication. After identifying the problem, the most important step is to teach problem-solving skills together. Violence, economic problems, and alcohol or substance abuse are serious problems in marriage. Infidelity is also a frequently encountered problem.
\nOA: How do technology and big cities affect relationships?
\nMZS: That's a topic in itself\u2026 I have a presentation called 'Technology and Humanity,' and I always say there; the most advanced technology is the one that has become ingrained in your being. That technology is present in your life every moment, but you're not aware of it. Technology certainly fascinates people. Many dreams that we can't realize in our society can be realized in the virtual world. To put it simply; we can access many things with technology that we can't access in daily life. You're not actively present in daily life, but in the world of technology, you can be the 'most important person' in an email group or a game. There's even a virtual world where you can reset yourself and start everything anew with a new identity. On the other hand, this virtual and electronic world alienates us from each other. Our communication skills decrease, we develop a jargon specific to technology, and that jargon isn't valid in real life. It becomes difficult to adequately express our emotions. The icons used in expressing emotions can never reflect real life. In reality, you use your five senses in face-to-face relationships, but you have to fill the gaps there with your imagination. Therefore, there can be many people who meet online and end up disappointed.<\/p>\n
OA: Has the internet made people more impatient and careless in their relationships? At the slightest problem, they say, "There are dozens of others like you on the internet?"
\nMZS: \u201cIf you say, \u201cI could find ten more like you,\u201d you don\u2019t really love that man or woman. That\u2019s something younger people might say. Love is \u201cI love you because I need you,\u201d while affection is \u2018I need you because I love you.\u2019 There\u2019s a big difference between the two. While technology makes it easier to connect, it can also lead to things being consumed faster\u2026\u201d<\/p>","protected":false},"excerpt":{"rendered":"
T\u00fcrkiye\u2019deki Kognitif Davran\u0131\u015f Terapileri Derne\u011fi\u2019nin kurucusu ve ba\u015fkan\u0131 ve ge\u00e7mi\u015fte Avrupa Kognitif ve Davran\u0131\u015f Terapileri Birli\u011fi Ba\u015fkanl\u0131\u011f\u0131 yapm\u0131\u015f olan Prof. Dr. Mehmet Zihni Sungur ile \u2018futbollu\u2019-\u2018T\u0131p\u2019l\u0131, T\u00fcrkiyeli-Avrupal\u0131, dernekli-e\u011fitimli, tak\u0131nt\u0131l\u0131-depresyonlu, bir r\u00f6portaj. Canl\u0131 kay\u0131ttan, naklen yaz\u0131ya\u2026 R\u00f6portaj: Ozanay Alpkan O.A.: Her zamanki gibi \u2018kariyer \u00e7izgisi\u2019 ile ba\u015flayabiliriz\u2026 Uzmanl\u0131k alan\u0131n\u0131z\u0131 nas\u0131l belirlediniz? Nas\u0131l ilerledi? M.Z.S.: Kariyer \u00e7izginiz […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[3],"tags":[],"class_list":["post-55","post","type-post","status-publish","format-standard","hentry","category-roportajlar"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pavKUa-T","jetpack-related-posts":[],"_links":{"self":[{"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/posts\/55","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/comments?post=55"}],"version-history":[{"count":0,"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/posts\/55\/revisions"}],"wp:attachment":[{"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/media?parent=55"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/categories?post=55"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/mehmetsungur.com.tr\/en\/wp-json\/wp\/v2\/tags?post=55"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}